Efficacy and safety of metallic stents in patients with unresectable pancreatic cancer receiving gemcitabine.
OBJECTIVE
Expandable metallic stents (EMSs) are widely used to palliate unresectable malignant biliary obstructions. The efficacy and safety of EMS in patients receiving gemcitabine (GEM) for unresectable pancreatic cancer is evaluated.


METHODS
Data for 147 patients with unresectable pancreatic cancer were studied retrospectively: 52 received GEM without EMS, 36 received GEM with EMS, 27 received only best supportive care (BSC) without EMS, and 32 received BSC with EMS.


RESULTS
Expandable metallic stent did not increase adverse effects (>grade 2) caused by GEM (P = 0.809), and the rates of infections other than cholangitis and cholecystitis were neither increased by GEM nor by EMS (P = 0.287). Cholangitis and cholecystitis occurred exclusively in patients with EMS and was managed successfully. Tumor extension, good performance status, and GEM, but not EMS, were shown to affect survival. Stent-related complications were observed in 26 patients (72%) receiving GEM and in 17 patients (53%) with BSC (P = 0.133). Multivariate analyses revealed no predictors for stent-related complications, although the use of covered EMS and good performance status were associated with longer stent patency. Gemcitabine affected neither stent-related complications nor stent patency.


CONCLUSIONS
Expandable metallic stent placement is safe and effective in patients with unresectable pancreatic cancer receiving GEM. Gemcitabine improves survival irrespective of EMS placement.
Nakai
Yousuke
Y
Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Tokyo, Japan. ynakai-tky@umin.ac.jp
Isayama
Hiroyuki
H
Kawabe
Takao
T
Tsujino
Takeshi
T
Yoshida
Haruhiko
H
Sasaki
Takashi
T
Tada
Minoru
M
Arizumi
Toshihiko
T
Yagioka
Hiroshi
H
Kogure
Hirofumi
H
Togawa
Osamu
O
Ito
Yukiko
Y
Matsubara
Saburou
S
Hirano
Kenji
K
Sasahira
Naoki
N
Omata
Masao
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D002761:Cholangitis / Q000209:etiology; D002764:Cholecystitis / Q000209:etiology; D002779:Cholestasis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D008670:Metals; D003841:Deoxycytidine; D000093542:Gemcitabine